Derbyshire GP Dr Peter Holden - a GPC member for more than three decades - told the Rural Primary Care Conference in Wales this week that the shortage of GPs and soaring workload left practices with little choice but to find new ways of working.

Collaboration through practice mergers, federations or networks and other new models of care were inevitable, Dr Holden told the conference.

'Nothing has changed in the last year,' Dr Holden said. 'We have recruitment failure and a retirement bulge. We are short of money and short of workforce and this is the introspection we are working with in the health service.

'The government is talking about 5,000 more GPs on the list by 2020, but they don’t mention that 8,000 GPs will have left the list by then. There are whole swathes of the country relying on locums. We have got to get our workload down because we need 66,000 GPs to deliver the current service when there are only 40,000 of us.'

He added: 'We have got to work collaboratively, that’s the way things are going and consequently we have no choice, but it does give you sustainability.'

NHS Brexit impact

The former GPC negotiator also warned that Brexit was likely to hit both NHS funding and its workforce. As Health Education England's updated mandate from the government revealed on Thursday that it had been asked to draw up plans within a year to 'reduce NHS demand for migrants', Dr Holden warned that that NHS was dependent 'to quite a large extent' on EU workers.

He added: 'If the pound continues to become a target for speculators that means austerity much bigger than now. The pound has become a political play thing.

'The health service can only survive on what the government can tax and if the tax take goes down, they won’t have the money to spend. The economy is going sour big-style in a way that this nation has not seen since the 1930s and that means trouble in our domestic and professional budgets.

'The run on the pound means increased costs of running a health practice. If we get practice expenses inflation running at 10%, that’s a 20% pay cut for you and less to spend on healthcare. The only thing that has saved us in the last five years is the fact that interest rates and inflation were low.'

Welshpool GP Dr Michael Lewis told the conference that the face of general practice was changing, as workforce issues forced practices to increase skill mix and use new technology, such as phone consultations and telehealth.

'If we don’t do this, GP services will start to fail. We’re very pleased that the new approaches do seem to be both helping and are safe, but more needs to be done.'